ATH-05 Can protocolised measurements with barium radiology predict severity and treatment outcomes in zenker's diverticulum?. Issue 2 (June 2019)

• Record Type: Journal Article
• Authors: Siau, Keith; Aziz, Akhmid; Hall, Adrian; Lee, Min; Mohaghegh, Hamid; Priestnall, Linzie; Gait, Andrea; Mulder, Chris J; Ishaq, Sauid
• Is Part Of: Gut. Volume 68:Issue 2(2019)
• Page Start: A6
• Page End: A7
• Publication Date: 2019-06
• Subjects: Gastroenterology -- Periodicals; 616.33
• DOI: 10.1136/gutjnl-2019-BSGAbstracts.12
• Languages: English
• ISSNs: 0017-5749

Abstract

Abstract : Introduction: Barium swallow is an established investigation for Zenker's diverticulum (ZD), yet, no agreed measurement protocol exists for the evaluation of ZD on Barium radiology. We developed a standardised protocol to measure ZD dimensions on Barium radiology, and aimed to correlate ZD dimensions with symptoms, procedural difficulty and treatment outcomes. Methods: This prospective single-centre study included patients with symptomatic ZD undergoing flexible endoscopic septal division (FESD) as day case procedures between 2014–2018. Patients underwent Barium swallow imaging; ZD dimensions (figure 1) were measured and agreed by two expert radiologists using a predefined protocol. Symptom severity pre- and post-FESD was recorded using the Dysphagia, Regurgitation, Complications (DRC) scale. 1 Procedural difficulty was rated on a three-point scale: easy, moderate, difficult. The primary outcome was therapeutic success, defined as remission following single episode FESD with a DRC score of 1 or less art 6 months of follow-up. ZD dimensions were subjected to Mann-Whitney tests and logistic regression analyses. Results: In total, 68 patients (mean age 74.2, SD 11.8) underwent barium radiology. Male gender comprised 60.9% of the cohort and was associated with larger pouch height (P=0.008), width (P=0.004) and depth (P=0.045). A positive correlation was identified between baseline DRC score and pouch depth (rho 0.319, P=0.012), particularly the symptom of regurgitation (P=0.009). No significant associations were found between ZD dimensions and procedural difficulty. Overall, each patient underwent an average of 1.4 FESD procedures. The outcome of therapeutic success at 6-months was achieved in 69% and was associated with shorter pouch height (median 14.5 mm vs. 19 mm, P=0.030) and pouch width (median 20 mm vs. 28 mm, P=0.046), with smaller cricopharyngeal length tending towards significance (median 20.8 mm vs. 26.3 mm, P=0.051). On multivariable analysis using a forward stepwise approach, pouch height was the sole dimension affecting the study outcome, with each additional mm in pouch height associated with a decrement in the probability of therapeutic success (OR 0.946, 95% CI: 0.897–0.997, P=0.031). Conclusions: ZD dimensions may be feasibly evaluated using Barium radiology. Specific parameters, especially those relating to the pouch, appear to correlate with baseline severity and post-FESD patient outcomes. These results may inform the planning of FESD in day case patients with ZD. Reference: Battaglia G, Dig Endosc 2015. PMID: 25975384.